New data, presented at the American Heart Association’s Scientific Sessions, point to the clinical and economic value of cardiac resynchronization therapy (CRT) devices for the treatment of heart failure, including a significant reduction in all-cause 30-day readmissions after heart failure hospitalizations. Additionally, heart failure patients who benefited early from CRT lived longer and consumed fewer hospital resources than patients who did not experience early benefit from the therapy.

Background

It’s AHA week in Chicago, and Medtronic is touting data from separate presentations that it says provide strong evidence of the clinical and economic value of its CRT devices. Remember one million people with heart failure are hospitalized each year in the U.S. 25 percent of them will be re-hospitalized within 30 days. Heart failure consumes intensive resources during hospitalizations and continues to cause problems following hospital stays, with six-month readmission rates of 50 percent and mortality rates of approximately 30 percent. On the basis that one man’s problem can be another’s opportunity, Medtronic will be dancing in the streets at the clinical support for its devices.

CRT is designed to help the heart pump more effectively in a coordinated rhythm. A stopwatch-sized device implanted in the upper chest sends small electrical impulses to stimulate the heart muscle. CRT has already been proven to be a cost-effective and beneficial therapy for indicated patients, reducing the risk of death and offering improvements in quality of life, cardiac structure and function for heart failure patients.

“Clinical and Economic Value of Maximizing Response to Cardiac Resynchronization Therapy (CRT): Evidence from Five Randomized Controlled Trials.” Patients who improved or remained unchanged six months after CRT were projected to live longer and consumed fewer hospital resources (i.e. fewer and/or shorter heart failure-related hospitalizations), than patients who worsened.

Pooled analysis of five Medtronic-sponsored trials (MIRACLE, MIRACLE-ICD, InSync III Marquis, PROSPECT and Adaptive CRT) identified 1,603 total patients, 1,089 of which improved (68 percent), 235 remained unchanged (15 percent) and 279 worsened (17 percent). Patients who improved or remained unchanged at six months of receiving CRT were projected (using Markov modeling) to live approximately eight years compared to less than two years in the worsened group. Additionally, heart failure hospitalization rates in the first year after the six-month clinical composite score assessment were 0.13 for those who improved, 0.27 for those who were unchanged and more than three times higher (0.90) for those who worsened (p<0.0001).

Physician comments

“The efficient management of heart failure is a growing priority for healthcare,” said Linda Gillam, M.D., MPH, chair, Cardiovascular Medicine, Atlantic Health System. “These new economic data reinforce the important benefits of CRT and demonstrate its value, not only for patient health, but also the fiscal health of the hospitals and health systems that treat them.”

Company comments

“Medtronic is committed to bringing forward sound innovation that improves patients’ lives and provides economic value by reducing cost to the healthcare system,” said David Steinhaus, M.D., vice president and general manager, Heart Failure, and medical director for the Cardiac Rhythm and Heart Failure Business at Medtronic. “Cardiac resynchronization therapy is an important tool in the management of heart failure and these data are a prime example of how innovations, including Medtronic’s AdaptivCRT pacing algorithm, can enhance the clinical and economic value of an already proven therapy.”